July 24, 2009

So, what if major Health Care Reform passed, and people were hopeful, but...many important reforms were scheduled for distant years like 2013 so that some important reforms just....didn't happen for years....

And meanwhile, people would feel the reality of one year into reform, say fall 2010, feels like the real result of Health Care Reform....

$0 out-of-pocket rules for diabetic and high-blood pressure maintenance programs and for all such very-high-payoff care on a federal list based on existing research on which preventive procedures are most cost-effective

All Insurers and Medical Providers required to work together towards complete pricing lists that cover all possible charges and also calculate patient out-of-pocket expenses for various policies -- an ongoing master Price List -- with the expectation that any charges not on the Price List will be outlawed starting 6 months after the law is enacted. The aim is price disclosure to patients during visits before treatments.

All insurers required to issue simple, clear disclosures to policy-holders that meet a Federal standard for clarity and list precisely what is excluded from a policy's coverage in simple, clear language. Policy-holders must return to the insurer this signed disclosure sheet or else be automatically moved within 60 days to a Federal Minimum Standard that eliminates loopholes in coverage, raises benefit caps to $5 million, caps deductibles at Federally-set levels ($500), and sets co-insurance percentages (portion insurer pays) to 70% or higher.

6 months from passage:

Medical providers required to disclose complete price and out-of-pocket cost information (from the ongoing Price List) to patient or guardian for each expected or likely treatment before the treatment, and obtain signature, in all non-emergency situations.

Guaranteed health insurance issue (acceptance) and guaranteed preexisting condition coverage rules for all private health insurers; no more rescissions allowed for any reason.

Everyone not with insurance required to purchase at least a low-cost, basic policy that meets federal minimum standards, or more. The federally-defined minimum policy would cover every treatment on a federal list of common, cost-effective treatments that have generally been in widespread use for at least 5 years, including common-sense benefits like maternity, and have federally set deductible caps and out-of-pocket caps, which could be higher in the case of a Health Savings Account up to the account balance.

1 year from passage:

Most remaining provisions of health care reform

...

One thing everyone learns if they lead a project against a deadline, remodel a house, do an difficult auto-repair, or other such common experiences is...it can be done.

It's time for us to stop underestimating the ability of Americans that work in the health care system.